Lost in Medicare Part D land
Jacqueline Vance, RN
My mom called me to relay her "tragic" story of trying to sign up for a Medicare Part D plan. She hadn't signed up for one, and didn't feel that she needed one, but at lunch her girlfriends were discussing the pros and cons of their plans and asked Mom what plan she was on.
They convinced her that while she might be on only one medication now, she surely could not predict the future. To be safe, she better sign up for the plan. And they told her that the longer she delayed, she would "get a penalty for not signing up every month for the rest of her life.”
"A penalty for not signing up, each month for the rest of my life?” Mom asked. "I thought I was saving the government money by not signing up." No, and she better hurry because the longer she waited, the more penalties she would have to pay. So, after more "the sky is falling" talk, Mom decided she better sign up before she had to pay a mortgage payment!
The next day, at 8:30 a.m., Mom called Medicare about a prescription plan. First, she talked to an automated machine, whose purpose was to take all of her pertinent information. The first clue this was not going to be easy was when the automated voice asked mom to give her birthdate in month, day and year. Mom, who is very articulate by the way, clearly gave this information. The "machine" repeated back something completely different. So mom pressed the number to do it again, and spoke slower and louder.
The "machine" again repeated back something completely different. This little game occurred several more times in which Mom was now screaming at this inanimate object. On the fifth attempt, apparently Mom is now violently yelling, "No you stupid “%$#@!” That is not what I said!"
Dad tells Mom to calm down — it is just a recording. Mom gives Dad ‘'the look” and asserts, "Well, the b@#*h won't listen." Dad takes the phone, punches in Mom's birth date, hands the phone back to her and adds a little “something-something” to Mom's coffee. (Apparently he has already run the gauntlet of government insurance sign-up).
Finally, Mom gets to a point where she is transferred to talk to a human being. This first person, Ann, takes mom's information again, 10 minutes worth, and then confirms that, yes, she was definitely going to have a penalty added every month for saving the government money these last few years because she dared to pay for her medications out of her own pocket (1% of an average something that mom did not understand).
What's the damage?
Mom queries what would that be in dollars? Ann says she was unable to answer that at this time because it is an "average." (Huh??) However, Ann states she will transfer mom to a David in enrollment who may be able to answer Mom's question.
David has to take mom's information again, all 10 minutes worth, (what everyone is doing with this information we will never know) but he immediately transfers Mom to a Patricia. Mom can't remember what department Patricia was in, but Patricia tells her she is going to have to pay a penalty of $18.10 a month for the rest of her life for not using the government insurance the last few years.
At this point, Mom asks how she was supposed to know that by saving the government money and paying for her own medication, this was a "bad thing” and she would be now punished for the rest of her living days. Patricia says it was up to Mom to read about Medicare Part D on the website and understand it.
Mom, who has problems using email, now adds a little more “something-something” to her coffee. Patricia says she is unable to take care of Mom anymore but will transfer her to a James in customer service who can.
Of course, Mom has to give James all of her information again. (Really, where is it going?) Mom now is asking if she pays for the premium monthly, yearly, etc. James replies that he doesn't know, but he will forward her to Pam in billing. Pam doesn't sound happy and admits, get this, she is having issues with her computer. She of course NEEDS mom's info again. Pam tells Mom she doesn't know why Mom doesn't understand anything because she should have received information in the mail.
So at this point, Mom is hitting the questions hard about billing; since she has never received anything by mail remotely related to Medicare Part D and is fearful she still won't receive anything and be further penalized. But Pam can't help mom because she is having computer issues.
Pam proclaims she is forwarding mom to a Kimella. However, instead Mom gets a recording that tells her to call back between the hours of 8:00 a.m. and 4:30 p.m. and is promptly disconnected. Mom and Dad are pretty sure that 10:38 am Eastern Standard Time is within the time frame of 8 a.m. to 4:30 p.m. (Dad said he would not repeat what Mom said next but at this point, her coffee probably doesn't have any coffee in it anymore!) After a gulp or two, Mom calls back and starts again with the automated machine. But having a “leg up,” she now knows she can punch in her birth date.
Finally, after going through the computerized process again, she reached Kimella. Kimella says she can't help mom (after, of course, taking the 10 minutes to gather Mom's information) and sends her to a Mikell, whom Mom believes was in sales of some sort. Mikell spoke English very poorly, but he was nice and polite.
Trying to strike up a conversation, Mom casually asked when he moved to the USA. Mikell becomes offended and states he is from the USA. Mom decides to stop talking. Mikell then explains the medication tiers to her. So after three hours on the phone and having spoken to six government employees, Mom now knows that the only medication she takes is a tier 3, so she has to pay 100% for that (generic is not equivalent) and she has to pay for a Medicare part D plan she does not really want, WITH and an additional penalty attached each month.
Mikell says Mom should have gotten something in the mail before but assured her she will receive her welcome kit in early December. She still doesn't understand how she will be billed, but Mikell said all would be explained in the “welcome kit.”
Welcome to your tax dollars at work!
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.